Question 1

During shift report it was noted that the off-going nurse had given the client a PRN dose of morphine 2 mg every 2 hours for incisional pain.  What current client assessment would most likely affect the oncoming nurse's decision to discontinue the administration every 2 hours?

Accepted Answer

A) Client reports burning during injection into the IV line 
B) Client reports dizziness when getting up to use the bathroom 
C) Client's blood pressure is 106/68 mm Hg 
D) Client's respiratory rate is 11/min

Question 2

A post-surgical client is unresponsive to painful stimuli and is given naloxone.  Within 5 minutes, the client is arousable and responds to verbal commands.  One hour later, the client is again difficult to arouse, with minimal response to physical stimuli.  Which actions should the nurse take?  Select all that apply.

Accepted Answer

A) Administer oxygen 
B) Assess respiratory rate 
C) Initiate rapid response or code team 
D) Notify the health care provider 
E) Prepare a second dose of naloxone

Question 3

A nurse has received new medication prescriptions for a client admitted with hypertension and an exacerbation of chronic obstructive pulmonary disease.  Which prescription should the nurse question?

Accepted Answer

A) Amlodipine 
B) Codeine 
C) Ipratropium 
D) Methylprednisolone

Question 4

An elderly client with a history of stable chronic obstructive pulmonary disease, alcohol abuse, and cirrhosis has a serum theophylline level of 25.8 mcg/mL (143 µmol/L).  Which clinical manifestation associated with theophylline toxicity should worry the nurse most?

Accepted Answer

A) Alterations in color vision 
B) Gum (gingival) hypertrophy 
C) Hyperthermia 
D) Seizure activity

Question 5

The clinic nurse is teaching a client about levothyroxine, which the health care provider has prescribed for newly diagnosed hypothyroidism.  Which statement made by the client indicates that further teaching is needed?

Accepted Answer

A) "I will need to get my blood drawn to see if I'm taking the right dose." 
B) "I will probably need to take this the rest of my life." 
C) "I will take this once a day in the morning." 
D) "If this makes my stomach upset, I will take it with an antacid."

Question 6

A client with atrial fibrillation is being discharged home after being stabilized with medications, including digoxin.  Which of the following statements regarding digoxin toxicity indicates that further teaching is needed?

Accepted Answer

A) "I must visit my health care provider (HCP) to check my drug levels." 
B) "I should report to my HCP if I develop nausea and vomiting." 
C) "I should tell my HCP if I feel my heart skip a beat." 
D) "I will need to increase my potassium intake."

Question 7

A client in the intensive care unit is receiving IV vancomycin and gentamicin.  The nurse should monitor for which potential complication with the administration of these medications?

Accepted Answer

A) Blood in nasogastric tube drainage 
B) Decrease in red blood cell (RB
C)  count 
C) Increase in serum creatinine level 
D) Onset of muscle aches and cramping

Question 8

A 21-year-old client is being evaluated in the outpatient psychiatric clinic after starting isocarboxazid 2 weeks ago.  Which of the client's statements needs to be addressed first?

Accepted Answer

A) "I am not sleeping well at night and would like a sleeping aid." 
B) "I do not know how well I will do on this restricted diet." 
C) "I have been having quite a bit of nausea and constipation." 
D) "This medicine is not working; I am so tired of being depressed."

Question 9

A nurse conducting rounds checks on a client receiving continuous total parenteral nutrition (TPN).  The infusion pump is found to be powered down, and TPN is no longer infusing.  Which action should the nurse take first?

Accepted Answer

A) Notify the health care provider that the infusion has stopped 
B) Obtain a blood specimen for serum electrolyte testing 
C) Obtain a STAT finger-stick capillary blood glucose level 
D) Remove the infusion pump and tag the device as malfunctioning

Question 10

A client is taking morphine sulfate for acute pain.  The client stands, is immediately "lightheaded," and calls for the nurse.  What is the nurse's priority action?

Accepted Answer

A) Assess the client's orthostatic blood pressure 
B) Assist the client to a sitting position 
C) Hold and walk with the client 
D) Keep the client on bed rest

Question 11

The nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers.  Which statement by the client would prompt further instruction?

Accepted Answer

A) "I can take this medication with food if it hurts my stomach." 
B) "I must use a reliable form of birth control while taking this medication." 
C) "I should continue to take my ibuprofen as prescribed." 
D) "I will take this medicine with an antacid to decrease stomach upset."

Question 12

The nurse administers IV vancomycin to a client with a methicillin-resistant Staphylococcus aureus infection.  Which nursing actions are most appropriate?  Select all that apply.

Accepted Answer

A) Assess client for lethargy and decreased deep tendon reflexes 
B) Assess skin for flushing and red rash on face and torso 
C) Infuse medication over at least 60 minutes 
D) Monitor blood pressure during infusion 
E) Observe IV site every 30 minutes for pain, redness, and swelling

Question 13

The nurse administers a dose of radioactive iodine to a female client for treatment of hyperthyroidism.  Which of the following precautions should the nurse teach the client to follow on discharge?  Select all that apply.

Accepted Answer

A) "Avoid close contact with pregnant women, infants, and children." 
B) "If applicable, you may resume breastfeeding when you return home." 
C) "If possible, use a separate toilet from your family, and flush 2 or 3 times after each use." 
D) "Use disposable cups, plates, and utensils, and do not share food items with others." 
E) "Wash your clothing and towels separately from the rest of the laundry in your home."

Question 14

A client with hypertension and type 2 diabetes has recently started taking chlorthalidone.  Which report by the client is most concerning to the nurse?

Accepted Answer

A) Dizziness on standing 
B) Fasting blood glucose of 160 mg/dL (8.9 mmol/L) 
C) Presence of muscle cramps 
D) Sunburn on both arms

Question 15

The registered nurse and practical nurse are conducting a workshop on contraceptive methods for a group of outpatient clients.  Which instructions should the nurses include when discussing combined estrogen-progestin oral contraceptives?  Select all that apply.

Accepted Answer

A) Consult the health care provider (HCP) if you experience leg pain or swelling 
B) Discontinue contraceptives if you experience spotting between menses 
C) Do not smoke while taking combined contraceptives 
D) Immediately report any breast tenderness to the HCP 
E) Seek immediate medical treatment if you experience vision loss

Question 16

A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate.  Which statement made by the student would require intervention by the nurse?

Accepted Answer

A) "Take this in the morning 1 hour before breakfast." 
B) "Take this with your other stomach medications." 
C) "Take your heart medication 2 hours after sucralfate." 
D) "You might experience constipation while taking this."

Question 17

A newly admitted client describes symptoms of dizziness and feeling faint on standing.  The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder.  Which medications may be contributing to the client's symptoms?  Select all that apply.

Accepted Answer

A) Atorvastatin 
B) Metformin 
C) Metoprolol 
D) Olanzapine 
E) Omeprazole

Question 18

The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day.  Which instructions should be included in the client's teaching plan?  Select all that apply.

Accepted Answer

A) "Discontinue hydrocortisone if you note mood changes or disruptions in behavior." 
B) "Make an appointment with an optometrist yearly to assess for cataracts." 
C) "Report even a low-grade fever to the health care provider (HCP) immediately." 
D) "Report signs of hyperglycemia, including increased urine, hunger, and thirst." 
E) "Take the medication on an empty stomach."
F)"The dose of hydrocortisone may need to be decreased during times of stress."

Question 19

A community health nurse evaluates several clients' vaccination status.  Which clients would the nurse recommend receive the influenza vaccine injection?  Select all that apply.

Accepted Answer

A) 9-month-old with no known medical conditions 
B) 5-year-old with congenital heart defect 
C) 23-year-old recently diagnosed with HIV 
D) 45-year-old caretaker of elderly parent 
E) 75-year-old with end-stage renal failure

Question 20

The nurse prepares to administer morning medications to assigned clients.  Which prescription should the nurse clarify with the health care provider?

Accepted Answer

A) Clopidogrel for client with history of stroke and platelet count of 154,000/mm3 (154 × 109/L) 
B) Losartan for client with hypertension who is 8 weeks pregnant 
C) Prednisone for client with herpes simplex lesions and Bell palsy 
D) Tiotropium for client with pneumonia and chronic obstructive pulmonary disease

Exam 8: Pharmacology

During shift report it was noted that the off-going nurse had given the client a PRN dose of morphine 2 mg every 2 hours for incisional pain. What current client assessment would most likely affect the oncoming nurse's decision to discontinue the administration every 2 hours?

A nurse has received new medication prescriptions for a client admitted with hypertension and an exacerbation of chronic obstructive pulmonary disease. Which prescription should the nurse question?

An elderly client with a history of stable chronic obstructive pulmonary disease, alcohol abuse, and cirrhosis has a serum theophylline level of 25.8 mcg/mL (143 µmol/L) . Which clinical manifestation associated with theophylline toxicity should worry the nurse most?

The clinic nurse is teaching a client about levothyroxine, which the health care provider has prescribed for newly diagnosed hypothyroidism. Which statement made by the client indicates that further teaching is needed?

A client with atrial fibrillation is being discharged home after being stabilized with medications, including digoxin. Which of the following statements regarding digoxin toxicity indicates that further teaching is needed?

A client in the intensive care unit is receiving IV vancomycin and gentamicin. The nurse should monitor for which potential complication with the administration of these medications?

A 21-year-old client is being evaluated in the outpatient psychiatric clinic after starting isocarboxazid 2 weeks ago. Which of the client's statements needs to be addressed first?

A nurse conducting rounds checks on a client receiving continuous total parenteral nutrition (TPN) . The infusion pump is found to be powered down, and TPN is no longer infusing. Which action should the nurse take first?

A client is taking morphine sulfate for acute pain. The client stands, is immediately "lightheaded," and calls for the nurse. What is the nurse's priority action?

The nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers. Which statement by the client would prompt further instruction?

The nurse administers IV vancomycin to a client with a methicillin-resistant Staphylococcus aureus infection. Which nursing actions are most appropriate? Select all that apply.

The nurse administers a dose of radioactive iodine to a female client for treatment of hyperthyroidism. Which of the following precautions should the nurse teach the client to follow on discharge? Select all that apply.

A client with hypertension and type 2 diabetes has recently started taking chlorthalidone. Which report by the client is most concerning to the nurse?

The registered nurse and practical nurse are conducting a workshop on contraceptive methods for a group of outpatient clients. Which instructions should the nurses include when discussing combined estrogen-progestin oral contraceptives? Select all that apply.

A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. Which statement made by the student would require intervention by the nurse?

A newly admitted client describes symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? Select all that apply.

The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. Which instructions should be included in the client's teaching plan? Select all that apply.

A community health nurse evaluates several clients' vaccination status. Which clients would the nurse recommend receive the influenza vaccine injection? Select all that apply.

The nurse prepares to administer morning medications to assigned clients. Which prescription should the nurse clarify with the health care provider?